Statin use does not account for breast cancer prognosis in black women

ORLANDO, Fla. — Black women with newly diagnosed breast cancer report using statins at a rate similar to that of white women, indicating that differences in statin use are not the source of differences in cancer prognosis, according to a presenter here.

“Black women were more likely than white women have worse breast cancer prognosis, and to be obese, have insulin resistance and dyslipidemia,” Amanda Leiter, MD, MSCR, Icahn School of Medicine at Mount Sinai, told Endocrine Today.

Amanda Leiter

Statin drugs are often prescribed for these patients, and Leiter and colleagues assessed whether their use might mediate the relationship between race and breast cancer prognosis.

The researchers enrolled 587 women (100 black) with newly diagnosed primary invasive breast cancer and no known diabetes. They recorded pre-surgery fasting lipid and glucose levels, as well as self-reported sociodemographic characteristics, medical comorbidities, medications and access to care. BMI was calculated and waist circumference measured at the first study visit. Using final pathology reports on tumor characteristics, researchers determined the women’s Nottingham prognostic index (NPI) and divided them by prognosis: better (NPI 4.4) and worse (NPI > 4.4). Statin use was compared with anthropometric and sociodemographic characteristics using chi-square test or t-test according to race and prognosis. Multivariate logistic regression was used to control for confounders.

Among the cohort, black women were more likely to have obesity (47% vs. 19%; P < .01), lower HDL (61 mg/dL vs. 69 mg/dL; P < .01) and triglycerides (87 mg/dL vs. 100 mg/dL; P = .03), and more triple-negative receptor disease (14% vsd 7%; P = .02) vs. white women; LDL levels were similar between the groups. Black women were also more likely to have worse prognosis (27% vs. 15.4%; P = .009), obesity (BMI 30 kg/m², 23% vs. 16%; P = .07) and premenopausal status (21% vs. 14%; P = .02) compared with white women. An association with LDL level (107 mg/dL vs. 115 mg/dL; P = .06) and black race neared significance.

Regarding statins, black women were more likely than white women to report their use (18% vs 11%; P = .07). Statin use was not associated with prognosis. Black race was associated with poor prognosis in the model adjusted for age, LDL, menopausal status, metabolic syndrome and health care access (OR = 2.13; 95% CI 1.23-3.67).

“Importantly, we found that among breast cancer patients, black women were just as likely as white women to take statins. Black women were more likely than white women to be obese, have insulin resistance and dyslipidemia, yet few studies have specifically investigated how these differences are associated with racial disparities in breast cancer outcomes,” Leiter said. “More studies with larger populations and longer follow-up should investigate the differential effects of dyslipidemia, statin use, obesity and insulin resistance on breast cancer outcomes in black and white women. In the meantime, it is reassuring to know that there was no racial disparity in statin use in our study.” – Jill Rollet

Reference:

Leiter A, et al. SH04-5. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2017; Orlando, Fla.

Disclosures: Leiter reports no relevant financial disclosures.